I need to have a septal hole repaired along with augmentation of an upturned shortened nose from a previous rhinoplasty. Found a wonderful ENT/PS who recommends cadaver cartilage. He can use that or one or both of my ears. I am reading so much on the possibility of warping and reabsorption that I am so confused. What are the experiences of most revisionist these days? Is cadaver cartilage really safe? What happens if it does warp or reabsorb? Thank you very much for the advice.
Is Cadaver Cartilage for Revision Better Than Ear Cartilage?
Doctor Answers 7
Autologous vs Irradiated Rib Cartilage in Revision Rhinoplasty
There are Pros and Cons for using Irradiated vs Autologous Rib Cartilage in Revision Rhinoplasty Patients-
1. Irradiated Rib Cartilage- No donor site morbidity, ease of use , less warping but more resorption than Autologous Rib Cartilage
2. Autologous Rib Cartilage- Abundant, donor site morbidity, ease of carving, more warping tendency but less resorption .
In my personal experience, I have moved to using only autologous material- septum , ear or rib in the management of revision rhinoplasty patients for enhanced long term results, safety ,and less resorption rates .
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Irradiated Cadaver vs Ear Cartilage in Nasal Revision
Irradiated cadaver cartilage is safe but the problem with absorption will vary depending on your surgeon's source of that cartilage. After 35 years of doing revision rhinoplasty I have used all these materials and now prefer to use the patient's own cartilage from the septum, ears, or rib. If adequate cartilage can be harvested from your ears, that would be my first choice.
Irradiated cadaver rib (costal) or ear cartilage for revision nose job (rhinoplasty)
There appear to be trends and conflicting information on the use of irradatiated rib cartilage. Clearly the advantages are that no donor site or additional srugery is necessary. However, any rib cartilage yours or a cadaver can warp. Interventions such as metal wires placed into the graft may help minimize this tendency but may require removal at a later date. Ear cartilage will not be rejected but the ability to shape of provide sufficient bulk or structure may be more limited.
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Irradiated Rib Cartilage
Good question. There is still some controversy regarding the use of irradiated cadaveric rib cartilage in nasal reconstruction. The main concern was not safety, but resorption of the homologous rib graft over time. Recent studies have shown that about one third of these grafts will lose support and resorb over time. This would be a problem in cases like yours, were the surgeon is trying to lengthen the nose or reconstruct the septum. In bigger reconstructive cases, a patient's own rib cartilage would be my first choice. However, if (for whatever reason) rib harvest is not available, then irradiated homologous rib grafts would be my next best option in these cases.
Cadaver cartilage is am excellent choice
What is the right graft for revision rhinoplasty
Dear Rhinoplasty Patient from Florida,
Irradiated cadaver cartilage is an excellent choice for most revision rhinoplasty cases. Remember having cartilage harvested from your ears or ribs requires additional surgery and recovery. It seems your facial plastic surgeon has a good handle of the situation. Talk to him for more information. Good luck.
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